tic technique to avoid inadvertent touch contamination during mixing ofsolutions and subsequent admixtures.
Parenteral nutrition solutions should be used promptly after mixing. Any storage should be underrefrigeration for as brief a time as possible. Administration time for a single bottle and set should neverexceed 24 hours.
Consult the medical literature for a discussion of the management of sepsis during central venousnutrition.
In brief, typical management includes replacing the solution being administered with a freshcontainer and set, and the remaining contents are cultured forbacterial or fungal contamination.
If sepsispersists and another source of infection is not identified, the catheter is removed, the proximal tipcultured, and a new catheter reinserted when the fever has subsided. Non-specific, prophylacticantibiotic treatment is not recommended. Clinical experience indicates that the catheter is likely to be theprime source of infection as opposed to aseptically prepared and properly stored solutions.
Metabolic
The following metabolic complications have been reported: metabolic acidosis, hypophosphatemia,alkalosis, hyperglycemia and glycosuria, osmotic diuresis and dehydration, rebound hypoglycemia,elevated liver enzymes, hypo- and hypervitaminosis, electrolyte imbalances, and hyperammonemia in
pediatric patients. Frequent clinical eva luation and laboratory determinations are necessary, especiallyduring the first few days of central venous nutrition, to prevent or minimize these complications.
ADVERSE REACTIONS
See "WARNINGS" and "Special Precautions for Central Venous Nutrition."
Reactions which may occur because of the solution or the technique of administration include febrileresponse, infection at the site of injection, venous thrombosis or phlebitis extending from the site ofinjection, extravasation and hypervolemia.
Local reactions of the infusion site, consisting of a warm sensation, erythema, phlebitis and thrombosis,have been reported with peripheral amino acid infusions, especially if other substances are alsoadministered through the same site.
Generalized flushing, fever and nausea have been reported during peripheral administration of amino acids.
Symptoms may result from an excess or deficit of one or more of the ions present in the solution;therefore, frequent monitoring of electrolyte levels is essential.
If electrolyte supplementation is required during peripheral infusion, it is recommended that additivesbe administered throughout the day in order to avoid possible venous irritation. Irritating additivemedications may require injection at another site and should not be added directly to the amino acidinfusate.
Phosphorus deficiency may lead to impaired tissue oxygenation and acute hemolytic anemia. Relative tocalcium, excessive phosphorus intake can precipitate hypocalcemia with cramps, tetany and muscularhyperexcitability.
If an adverse reaction does occur, discontinue the infusion, eva luate the patient, institute appropriatetherapeutic countermeasures and save the remainder of the fluid for examination if deemed necessary.
OVERDOSAGE
In the event of a fluid or solute overload during parenteral therapy, reeva luate the patient's condition,and institute appropriate corrective treatment.
DOSAGE AND ADMINISTRATION
The total daily dose of 10% FreAmine® III (Amino Ac |
